Congenital fibrous, cartilaginous or bony union between two or more tarsal bones. Considered to be a failure of differentiation or segmentation of primitive mesenchyme lack of complete joint formation. Most commonly medial talocalcaneal, calcaneonavicular, posterior talocalcaneal, talonavicular – can affect all tarsal bones. 50% are bilateral. Prevalence is unknown, but is assumed to be <1%.
Aetiology unknown – occur as an isolated problem or part of a syndrome (eg Apert’s syndrome);
Clinical features:
Depends on site, but as coalition ossifies becomes rigid and maybe painful peroneal spastic flat foot may develop. Pain/aches in region and decreased range of motion are most common features.
Usually becomes symptomatic around ages 8-12yrs for calcaneonavicular and 12-16yrs for talonavicular coalitions.
X-ray:
Most visible on x-ray – special views may need to be ordered. CT scans are helpful.
Secondary signs on x-ray:- talar beaking; narrowing of posterior talocalcaneal joint space; broadening or rounding of lateral process of talus; failure of visualisation of the middle facets of anterior STJ; elongation of anterior process of calcaneus
Treatment:
Pain relief – NSAID’s; activity restriction; strapping; physical therapy; achilles tendon/calf muscle stretching.
Short leg cast immobilisation for 6 weeks,
Orthoses to restrict motion – may need to hold foot in pronated position
Surgical resection of coalition is indicated if conservative treatment is unsuccessful and pain is persistent
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